MEDICARE: ANJA MARINA ULLRICH PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	9222	MA

General Provider Information

NPI Number	:	1720398316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJA MARINA ULLRICH PH.D

Provider Business Mailing Address
First Line	:	62 DERBY ST STE 6
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-3718
Country	:	US
Telephone Number	:	671-791-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 DERBY ST STE 6
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-3718
Country	:	US
Telephone Number	:	671-791-1403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	04/13/2019

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